If you or someone you love has diabetes you are probably aware that diabetes causes small blood vessel disease. What happens is blood vessels weaken and slow the flow of blood through the body which can lead to diabetic neuropathy or organ and tissue damage.
Since I am an audiologist, I am particularly interested in what diabetes does to our inner ears. Both of our inner ears are made up of a cochlea and vestibular system.
Did you know that the same cranial nerve (8th nerve) innervates both the cochlea and the vestibular system? That is why I sometimes see patients with both hearing loss and balance issues. Since diabetes affects the entire neural system it is not uncommon for patients to report a disruption in the perception of hearing and balance as a whole.
Hearing Loss, How It Happens
Just like high blood glucose can damage organs such as eyes and kidneys it can also damage the inner ear. Our inner ears are extremely sensitive to blood flow and even our eardrums include a network of small blood vessels.
I often tell my patients a hearing evaluation is one of the easiest ways to identify if there has been any damage in the cochlea, the organ of hearing. Unlike a vision test where an optometrist can look into the back of your eye for signs of diabetic retinopathy, we cannot look into your ears and visualize the inner ear, your eardrum is blocking our view!
If damage has occurred in the cochlea it will show up as a sensorineural hearing loss. This type of hearing loss is referred to as nerve damage that cannot be regained through surgery or medication.
Balance, How It Happens
As I mentioned above diabetes also affects balance. When there is too much sugar in the blood it can affect our balance in more ways than one:
- It affects the connective tissues inside the vestibular system making one feel off-balance.
- The myelin sheath that covers the vestibular nerves are damaged which doesn’t allow our inner ear to send messages properly to our brain.
- It can degenerate the hair cells inside the vestibular system just like it damages the hair cells inside the cochlea resulting in hearing loss.
As you can probably imagine we use several sensory inputs to remain balanced on our feet. One of the main inputs is our vision, can you see what is in front of you as you take a step? How about proprioceptive inputs like what your feet are telling you? If someone has a hard time feeling their feet, they may be stepping on a surface that isn’t level which will cause them to fall. Remember, diabetes affects the whole body and there are multiple systems at play when balance is an issue.
My Role As An Audiologist
Baseline Hearing Test
Baseline Hearing Test
I tell anyone who is suffering from diabetes that a baseline hearing test is an important starting point. It is important to have a complete picture of hearing at the time of diagnosis! Therefore, if any issues arise in the future we have something to compare to.
Another recommendation I commonly make may be diabetes education. Did you know that it is covered by Medicare? If you were recently diagnosed with diabetes you can get up to 10 hours of diabetes education when you’re first diagnosed.
Another recommendation may be a balance screening. If there are any concerns we can refer you for a balance screening and vestibular physical therapy.
I will commonly ask my patients how their eyesight is if they are diabetic and having issues with balance. Make sure that you or your loved one is getting an eye exam with dilation at least once a year. As mentioned above, vision health plays an important role in balance.
Dowd, K. (2020). Audiology: diabetes in hearing & balance care. AudiologyOnline, Article 27259. Retrieved from http://www.audiologyonline.com